A&E triage system is ‘as accurate as flipping a coin’
NHS hospitals give patients scores to identify who to send home but experts say the method is flawed
An NHS triage system aimed at pinpointing which A&E patients do not need hospital admission is as accurate as “flipping a coin”, health experts have admitted.
Same Day Emergency Care (SDEC) is used in most hospitals to free up beds by identifying which patients can be sent home on the same day they arrive at casualty departments.
Centres are encouraged to use scoring systems to select patients, such as the Amb score, recommended by the Royal College of Physicians, and the Glasgow Admission Prediction Score (GAPS).
NHS Improvement has highlighted use of the scoring systems as “good practice”.
But they are only 50 per cent accurate, experts have warned, largely because they were developed predominantly using results from white men, often in rural areas.
A document released by Health Data Research UK (HDRUK) and the National Institute for Health and Care Research (NIHR) warns: “We have tested their performance in a diverse urban population and found the ability to identify SDEC patients is 50 per cent – the same as flipping a coin.”
The Society of Acute Medicine (ASM) has been tasked with developing a new scoring system which will perform better, and give more confidence to patients.
It is one of 16 science and data projects launched by HDRUK and NIHR, to try and tackle pressure on the NHS, with results expected in the Spring.
Prof Cathie Sudlow, chief scientist at HDR UK, said: “As a doctor who has previously treated patients in the emergency department, I am all too aware of the enormous challenges faced by the healthcare system.
“It’s critical that we use data rapidly, securely and responsibly to support the
NHS, its workers, and the patients who rely on it for their care.
“Within three months, they will have honed in on key pain points in the health service, and developed evidence-led recommendations on how best to manage resources and prevent unnecessary illness through the winter.”
SDEC services were made a priority as part of the NHS Long Term Plan in 2019. At the time, Prof Stephen Powis, the NHS national medical director, said that SDEC services could prevent patients deteriorating from unnecessary or long stays in hospital.
It would also help to free up beds in hospital wards, and improve the flow of patients through A&E – allowing doctors and nurses to focus on those who need the most urgent care.
It meant, for example, that someone entering A&E with a deep tissue infection would be given antibiotics and then
sent home. If they needed further antibiotics, they would return to hospital for treatment in the coming days as an outpatient.
As part of the NHS Long Term Plan, all hospitals with a full Emergency Department were required to provide SDEC services, with the aim of a third of patients who require an emergency admission returning home the same day.
But feedback from patients has been lukewarm, with many feeling they are being made a lower priority. The ASM team said they would be working with patients to increase confidence.
Experts said: “It is hoped that this project will lead to improved processes that reduce unnecessary bed moves for patients and support better bed planning.”
Other projects include a study to investigate the impact of cold and damp homes on people’s health so that preventative steps can be taken before they need medical care.